System and method for facilitating repair and reattachment of comminuted bone portions

ABSTRACT

A fracture fixation system serves in repairing a comminuted humeral head of a humeral bone. The fracture fixation system includes a plate having an upper surface, a lower surface opposite the upper surface, one of a screw and a post, and at least one aperture for receiving the one of the screw and the post therethrough. The plate is secured to a portion of a humeral shaft of the humeral bone, and the one of the screw and the post is inserted through the at least one aperture through the plate. The portion of the comminuted humeral head is attached to the one of the screw and the post using at least one suture. The one of the screw and the post is rotated to wind the at least one suture therearound to reposition the portion of the comminuted humeral head relative to the portion of the humeral shaft.

RELATED APPLICATIONS

This non-provisional application claims the benefit of U.S. ProvisionalApplication No. 61/390082, filed Oct. 5, 2010, entitled “System andMethod for Facilitating Repair and Reattachment of Comminuted BonePortions”; U.S. Provisional Application No. 61/405438, filed Oct. 21,2010, entitled “Bone Plate with Soft Tissue Attachment Structure”; andU.S. Provisional Application No. 61/405,793, filed Oct. 22, 2010,entitled “Suture Anchor and Method of Use Associated Therewith”; theentire contents of U.S. Provisional Application Nos. 61/390,082,61/405,438, and 61/405,793 are hereby incorporated by reference herein.

BACKGROUND

1. Field of the Invention

The present invention is generally related to a medical device andmethod for use thereof for facilitating repair of comminuted bonefractures. In particular, the present invention is related to a fracturefixation system and method for use thereof to aid in the repair ofcomminuted periarticular fractures. More specifically, the presentinvention relates to a fracture fixation system and method for usethereof for aligning and stabilizing comminuted bone portions andassociated soft tissues adjacent joints to facilitating proper healing.

2. Description of the Prior Art

A comminuted periarticular fracture is a fracture in which bone isbroken, splintered, or crushed into a number of pieces adjacent a joint.In comminuted periarticular fractures there is a great need for fixationof important bony fragments (or comminuted bone portions) that haverelevant blood supply to facilitate fracture healing. Such comminutedbone portions may have tendons or ligaments attached thereto which alsoneed to heal in place in order to restore function to the joint inquestion. For example, as in fractures of the lesser tuberosity,frequently there are avulsed tendons that are attached to the comminutedbone portions.

A wide variety of devices have been developed for the support andtreatment of comminuted periarticular fractures. Existing solutions haveranged from simplistic measures, such as bone support plates, structuralrods, and other single-function prosthetic devices, to more elaboratemechanisms involving a complex arrangement of different components.Despite advances in the devices for the support and treatment ofcomminuted periarticular fractures, increasing the alignment andstability of the comminuted bone portions and associated tissue can aidin restoring function to the damaged joint.

Therefore, there is a need for a fracture fixation system to aid repairand reattachment of comminuted bone portions and associated tissue byfacilitating increased alignment and stability of the comminuted boneportions and associated tissue. Such a fracture fixation system canincrease the alignment and stability of the comminuted bone portions andassociated tissue by providing an ideal mechanical advantage for drawingmultiple comminuted bone portions together to form a solid construct tofacilitate healing thereof, and to facilitate attachment of theassociated tissue.

For example, the fracture fixation systems disclosed herein can be usedto fix portions of a comminuted humeral head relative to a humeral shaftportion (FIGS. 1 and 2). In doing so, the comminuted humeral headportions (whether they contain important blood supply, or importanttendon or ligament attachments) can be fixed to the site of theiravulsion or prior attachment. As such, using the fracture fixationsystems disclosed herein, the comminuted humeral head portions can bedrawn together to form a solid construct to facilitate healing thereof,and to facilitate attachment of the associated tissue. The fracturefixation systems disclosed herein include improvements to the inventionsdescribed in U.S. Provisional Application Nos. 60/523,960; 60/541,540;and 60/552,632; and U.S. application Ser. No. 10/993,723, which areincorporated herein by reference.

SUMMARY OF THE INVENTION

The present invention in one preferred embodiment includes a method ofrepairing a comminuted humeral head of a humeral bone, the methodincluding the following acts. A plate having an upper surface, a lowersurface opposite the upper surface, and at least one aperture forreceiving one of a screw and a post therethrough is provided. The plateis secured to a portion of a humeral shaft of the humeral bone. The oneof the screw and the post is inserted through the at least one aperturethrough the plate. The portion of the comminuted humeral head isattached to the one of the screw and the post using at least one suture.The one of the screw and the post is rotated to wind the at least onesuture around the one of the screw and the post, where the winding ofthe at least one suture draws the portion of the comminuted humeral headcloser to the one of the screw and the post to position the portion ofthe comminuted humeral head relative to the portion of the humeralshaft.

In another preferred embodiment, the present invention includes a methodof repairing a comminuted humeral head of a humeral bone, the methodincluding the following acts. A plate having an upper surface, a lowersurface opposite the upper surface, at least one fin extending outwardlyfrom the lower surface of the plate, and at least one aperture forreceiving one of a screw and a post therethrough is provided. The plateis secured to a portion of a humeral shaft of the humeral bone. The oneof the screw and the post is inserted through the at least one aperturethrough the plate. The portion of the comminuted humeral head isattached to the one of the screw and the post using at least one suture,where the at least one suture is received through an aperture formed inthe at least one fin and through a hole formed in the one of the screwand the post. The one of the screw and the post is rotated to wind theat least one suture around the one of the screw and the post, where thewinding of the at least one suture draws the portion of the comminutedhumeral head closer to the at least one fin and to the one of the screwand the post, and where the at least one fin is positioned between theportion of the comminuted humeral head and the one of the screw and thepost.

It is understood that both the foregoing general description and thefollowing detailed description are exemplary and exemplary only, and arenot restrictive of the invention as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate preferred embodiments of theinvention. Together with the description, they serve to explain theobjects, advantages and principles of the invention. In the drawings:

FIG. 1 is a perspective view of a first embodiment of a fracturefixation system positioned with respect to a comminuted portion of ahumeral head and a humeral shaft portion;

FIG. 2 is a perspective view of a second embodiment of the fracturefixation system positioned with respect to comminuted portions of thehumeral head and the humeral shaft portion;

FIG. 3A is a perspective view of a scaffold building screw of thefracture fixation system depicted in FIG. 2 illustrating a method forattaching sutures thereto;

FIG. 3B is a perspective view of the scaffold building screw depicted inFIG. 3A after the scaffold building screw of the fracture fixationsystem depicted in FIG. 2 has been rotated;

FIG. 4 is a side elevational view of an anchor post for use with thefracture fixation systems disclosed herein;

FIG. 5 is a perspective view of a modified suture and a malleable wirefor use with the fracture fixation systems disclosed herein;

FIG. 6 is a side elevational view of a suture anchor for use as part ofthe fracture fixation systems disclosed herein;

FIG. 7 is a front elevational view of the suture anchor depicted in FIG.6;

FIG. 8 is a perspective view of the suture anchor depicted in FIGS. 6and 7 in combination with a suture;

FIG. 9 is a perspective view of the suture anchor depicted in FIGS. 6-8in combination with the suture and a hollow needle;

FIG. 10 is a perspective view of another suture anchor for use as partof the fracture fixation systems disclosed herein;

FIG. 11 is a side devotional view of the suture anchor depicted in FIG.10 with a suture attached thereto and a complementary insertion toolinserted therethrough;

FIG. 12 is a perspective view of the suture anchor and the insertiontool depicted in FIG. 11 being inserted through a scaffold building postof the fracture fixation system depicted in FIG. 1;

FIG. 13 is a side elevational view of yet another suture anchor for useas part of the fracture fixation systems disclosed herein with acomplementary insertion tool;

FIG. 14 is a side elevational view of yet another suture anchor for useas part of the fracture fixation systems disclosed herein with acomplementary insertion tool;

FIG. 15 is a perspective view of a further suture anchor for use as partof the fracture fixation systems disclosed herein with a complementaryinsertion tool;

FIG. 16 is a side cross-sectional view of the suture anchor and theinsertion tool depicted in FIG. 15 being inserted into the scaffoldbuilding post or scaffold building screw of the fracture fixationsystems depicted in FIGS. 1 and 2;

FIG. 17 is a perspective view of a third embodiment of the fracturefixation system;

FIG. 18 is a top cross-sectional view of a fourth embodiment of thefracture fixation system positioned with respect to a repaired humeralhead;

FIG. 19 is a top cross-sectional view of the fourth embodiment of thefracture fixation system depicted in FIG. 18 in use with the sutureanchor depicted in FIGS. 15 and 16;

FIG. 20 is a perspective view of a fifth embodiment of the fracturefixation system;

FIG. 21 is a perspective view of a sixth embodiment of the fracturefixation system;

FIG. 22 is a perspective view of a seventh embodiment of the fracturefixation system;

FIG. 23 is a side cross-sectional view of an eighth embodiment of thefracture fixation system positioned with respect to a repaired humeralhead;

FIG. 24 is a side cross-sectional view of a ninth embodiment of thefracture fixation system positioned with respect to a repaired humeralhead;

FIG. 25 is an enlarged perspective view of a fin element of a tenthembodiment of the fracture fixation system;

FIG. 26 is a top cross-section view of the tenth embodiment of thefracture fixation system;

FIG. 27 is an enlarged perspective view of a fin element of an eleventhembodiment of the fracture fixation system; and

FIG. 28 is a top cross-section view of the eleventh embodiment of thefracture fixation system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The fracture fixation systems of the present invention depicted in theaccompanying drawings are used to facilitate repair and reattachment ofcomminuted bone portions and associated tissue. In doing so, thefracture fixation systems of the present invention serve in aligning andstabilizing comminuted bone portions and associated tissue adjacentjoints to facilitate proper healing.

A first illustrative embodiment of the fracture fixation system isgenerally indicated by the numeral 10 in FIG. 1, and a secondillustrative embodiment of the fracture fixation system is generallyindicated by the numeral 100 in FIG. 2. Fracture fixation systems 10 and100 and the other illustrative embodiments of the fraction fixationsystem described herein can be used to aid repair and reattachment of acomminuted humeral head and the tissue associated therewith. In doingso, components of the fracture fixation systems described herein can beused to provide attachment points for one or more portions (referredhereinafter singularly as portion P) of the comminuted humeral head. Indoing so, fracture fixation systems described herein also can be used toprovide attachment points for reattachment of associated tissue T (suchas tendons and ligaments) associated with comminuted humeral headportion P. Thus, when describing attachment of comminuted humeral headportion P below, it will be assumed that associated tissue T also can bereattached to comminuted humeral head portion P using the components ofthe fracture fixation systems described herein.

Depending on the degree of comminution of the bone, either of fracturefixation systems 10 or 100 can be used. For example, fracture fixationsystem 10 includes two attachment structures to accommodate a higherlevel of comminution, and fracture fixation system 100 includes oneattachment structure to accommodate a lower level of comminution.However, although not shown herein, the number of attachment structuresincluded in fracture fixation systems 10 and 100 can be varied toaccommodate higher or lower levels of comminution. For example, fracturefixation system 10 can be provided with one of the attachment structuresdepicted in FIG. 1, fracture fixation system 100 can be provided withtwo of the attachment structures depicted in FIG. 2, or both fracturefixation systems 10 and 100 can be provided with three or more of theattachment structures associated therewith. Furthermore, the attachmentstructures associated with FIGS. 1 and 2 can be interchangeable and beused together with one another.

As discussed above, fracture fixation systems 10 and 100 are discussedin association with a humeral bone H, in particular the comminutedhumeral head. More specifically, in FIGS. 1 and 2, fracture fixationsystems 10 and 100 are depicted to illustrate fixation of the lessertuberosity in fractures of the proximal humerus. However, fracturefixation systems 10 and 100, as well as the other illustrativeembodiments of the fracture fixation system disclosed herein, are not solimited and can be utilized with other comminuted bone portions and thetissue associated therewith.

Fracture fixation system 10 of FIG. 1 includes an external plate portion12 having screw apertures 14. External plate portion 12 is secured tohumeral bone H. For example, as depicted in FIG. 1, external plateportion 12 is attached to the exterior surfaces of humeral shaft portion16 of humeral bone H. Furthermore, depending on whether additionalportions of the comminuted humeral head remain attached to humeral shaftportion 16, external plate portion 12 can also be attached to theexterior surfaces thereof.

Screw openings (not shown) that respectively register with screwapertures 14 n external plate portion 12 are provided in humeral shaftportion 16, and if available, the additional portions of the comminutedhumeral head. The screw openings in humeral shaft portion 16, forexample, are formed in generally transverse relationships with respectto the longitudinal axis of humeral shaft portion 16.

To attach external plate portion 12 to humeral bone H, plate screws 20are respectively received in screw apertures 14 of external plateportion 12 and the screw openings in humeral shaft portion 16, and, ifavailable, the additional portions of the comminuted humeral head. Ifnecessary, plate screws 20 can be respectively locked to screw apertures14 by, for example, providing cooperating screw threads (not shown) onthe exteriors of plate screws 20 and on the interior surfaces of screwapertures 14.

As depicted in FIG. 1, two attachment structures in the form of scaffoldbuilding posts 22A, 22B are received in scaffold building post apertures24A, 24B, respectively, provided in external plate portion 12. Scaffoldbuilding posts 22A, 22B each include a shaft 28 and a head 30. Shaft 28can be provided with threads (not shown) to facilitate attachmentthereof to larger portions of the comminuted humeral head. Furthermore,if necessary, scaffold building posts 22A, 22B can be locked to scaffoldbudding post apertures 24A, 24B, respectively. For example, this may beaccomplished by providing complementary threads (not shown) on theexterior of head 30 and on the interior of scaffold building postapertures 24A, 24B.

Scaffold building posts 22A, 22B with or without fenestrations can beused to facilitate attachment of comminuted humeral head portion Pthereto. If no fenestrations are provided, sutures, wires, or cables canbe wrapped around scaffold building posts 22A, 22B to facilitateattachment of comminuted humeral head portion P thereto.

Alternatively, one or more bracing apertures 32 and 34 can extendtransversely through shafts 28 of each of scaffold building posts 22A,22B. Bracing apertures 32 and 34 may be disposed in generallyperpendicular relationship or at any desired angle with respect to thelongitudinal axes of shafts 28. Bracing apertures 32 and 34, forexample, can be disposed in generally perpendicular or transverserelationships with respect to each other. As discussed below, bracingapertures 32 and 34 are used for anchoring comminuted humeral headportion P with respect to the remainder of humeral bone H.

Fracture fixation system 100 of FIG. 2 includes an external plateportion 102. Like external plate portion 12 of fracture fixation system10, external plate portion 102 is secured to humeral bone H. Fracturefixation system 100, but for the use of a single different attachmentstructure, has a similar configuration and is used in similar fashion tofracture fixation system 10 (FIG. 1). Thus, where applicable, identicalelement numbers are applied to elements shared by fracture fixationsystems 10 and 100 in FIGS. 1 and 2.

As depicted in FIG. 2, one attachment structure in the form of ascaffold building screw 104 is received in a scaffold building screwaperture 106 provided in external plate portion 102. Scaffold buildingscrew 104 is similar to scaffold building posts 22A, 22B, and includes ashaft 108 and a head 110, if necessary, scaffold building screw 104 canbe locked to scaffold building screw aperture 106. For example, this maybe accomplished providing complementary threads (not shown) on theexterior of head 110 and on the interior of scaffold building screwaperture 106.

Shaft 108 is threaded to facilitate attachment to a humeral head portion18. As depicted in FIG. 2, humeral head portion 18 is a large fragmentof the comminuted humeral head, and includes an opening (not shown)provided therein for receiving a portion of scaffold building screw 104.When scaffold building screw 104 is received in scaffold building screwaperture 106 and the scaffold building screw opening in humeral headportion 18, scaffold building screw 104 secures humeral head portion 18in relation to external plate portion 102 and humeral shaft portion 16.

Like scaffold building posts 22A, 22B, scaffold building screw 104 withor without fenestrations can be used to facilitate attachment of thecomminuted humeral head portion P thereto. If no fenestrations areprovided, sutures, wires, or cables can be wrapped around scaffoldbuilding screw 104 to facilitate attachment of comminuted humeral headportion P thereto.

Alternatively, one or more bracing apertures 112 can extend transverselythrough shaft 108 of scaffold building screw 104. Bracing apertures 112may be disposed in generally perpendicular relationship or at anydesired angle with respect to the longitudinal axis of shaft 108. Asdiscussed below, bracing apertures 112 are used for anchoring comminutedhumeral head portion P with respect to the remainder of humeral bone H.

When using fracture fixation systems 10 and 100, comminuted humeral headportion P is ultimately attached to scaffold budding posts 22A, 22Band/or scaffold building screw 104. The point of anchorage and line ofpull afforded by scaffold building posts 22A, 22B and scaffold buildingscrew 104 are otherwise unobtainable. The illustrative embodiments ofthe fracture fixation system disclosed herein provide an idealmechanical advantage for drawing multiple bone portions together to forma solid construct to facilitate healing thereof.

To facilitate attachment of comminuted humeral head portion P toscaffold building posts 22A, 22B and/or scaffold building screw 104,holes 120 can be provided in comminuted humeral head portion P. One ormore of sutures 122 (referred hereinafter singularly) can be passedthrough holes 120 and inserted into one of bracing apertures 32, 34, and112 to draw comminuted humeral head portion P toward the correspondingone of scaffold building posts 22A, 22B, and scaffold building screw104. As such, using the leverage provided by scaffold building posts22A, 22B and/or scaffold building screw 104, comminuted humeral headportion P can be positioned relative thereto, and hence, relative to thesurrounding bone portions.

Thereafter, suture 122 (attached to comminuted humeral head portion P)can be attached to the corresponding one of scaffold building posts 22A,22B and scaffold building screw 104 to secure comminuted humeral headportion P relative thereto and to surrounding bone portions. Forexample, if suture 122 is inserted into bracing aperture 112, suture 122can be tied to the portions of scaffold building screw 104 surroundingbracing aperture 112 to attach comminuted humeral head portion P toscaffold building screw 104.

Alternatively, suture anchors (such as anchor portion 142 of a modifiedsuture 140 discussed below) can be provided to secure comminuted humeralhead portion P relative to scaffold building posts 22A, 22B and/orscaffold building screw 104. Modified suture 140 can be attached tocomminuted humeral head portion P, and, as depicted in FIGS. 3A and 3B,for example, anchor portion 142 thereof can be inserted completelythrough bracing aperture 112 of scaffold building screw 104. Shaft 108of scaffold building screw 104 is not depicted with threads in FIGS. 3Aand 3B to better show the interaction between modified suture 140 andscaffold building screw 104. As depicted in FIGS. 3A and 3B, anchorportion 142 catches on the portions of scaffold building screw 104adjacent the exit to bracing aperture 112. In doing so, anchor portion142 prevents withdrawal of modified suture 140 from bracing aperture112, and hence, attaches comminuted humeral head portion P to scaffoldbudding screw 104.

With comminuted humeral head portion P attached to one of scaffoldbuilding posts 22A, 22B, and scaffold building screw 104 using suture122 and/or modified suture 140, the one of scaffold building posts 22A,22B and scaffold building screw 104 can be rotated to further strengthenthe attachment therebetween. That is, rotation of the one of scaffoldbuilding posts 22A, 22B, and scaffold building screw 104 causes suture122 and/or modified suture 140 to wind therearound. Such winding drawscomminuted humeral head portion P closer to the one of scaffold buildingposts 22A, 22B, and scaffold building screw 104. For example, asdepicted in FIGS. 3A and 36, after anchor portion 142 is insertedthrough bracing aperture 112 to attach comminuted humeral head portion Pto scaffold building screw 104, scaffold building screw 104 can berotated to reposition bracing aperture 112 rotationally and windmodified suture 140 around shaft 108. In doing so, comminuted humeralhead portion P is drawn toward scaffold building screw 104, and theattachment of comminuted humeral head portion P and scaffold buildingscrew 104 is strengthened. Moreover, rotation of scaffold building screw104 and attendant repositioning of bracing aperture 112 also providesanother position for attachment of additional sutures thereto.

To maintain attachment of scaffold building posts 22A, 22B and scaffoldbuilding screw 104 relative to respective plate portions 12 and 102during rotation, the above-discussed complementary threads (not shown)are provided on heads 30 of scaffold building posts 22A, 22B, andprovided on head 110 of scaffold building screw 104. The threads onheads 30 interact with complementary threads provided in scaffoldbuilding post apertures 24A, 24B, and threads on head 110 interact withcomplementary threads provided in scaffold building screw aperture 106.The interaction of the threads maintains attachment of scaffold buildingposts 22A, 22B to plate portion 12 during rotation thereof, maintainsattachment of scaffold building screw 104 to plate portion 102 duringrotation thereof, and serves in preventing unwanted axial movement ofscaffold building posts 22A, 22B and scaffold building screw 104relative to their respective apertures. As such, suture 112 and/ormodified suture 140 can be wound around scaffold building posts 22A, 22Band/or scaffold building screw 104 without fear of detachment fromrespective plate portions 12 and 102.

Furthermore, in addition to the complementary threads for preventingunwanted axial movement, fracture fixation systems 10 and 100 can alsoinclude ratcheting mechanisms for preventing unwanted rotationalmovement of scaffold building posts 22A, 22B and scaffold building screw104 relative to their respective apertures. For example, heads 30 (ofscaffold building posts 22A, 22B) and head 110 (of scaffold buildingscrew 104) can each include teeth (not shown) surrounding an exteriorportion thereof. The teeth provided on heads 30 can interact with alatch (not shown) or complementary teeth (not shown) provided onexterior plate portion 12 and/or in scaffold building post apertures24A, 24B; and the teeth provided on head 110 can interact with a latch(not shown) or complementary teeth (not shown) provided on exteriorplate portion 102 and/or in scaffold building screw aperture 106. Theteeth on heads 30 and 110, and the corresponding latch or complementaryteeth can interact to prevent unwanted rotational movement of scaffoldbuilding posts 22A, 22B and scaffold building screw 104 relative totheir respective apertures. As such, such an interaction can serve inpreventing scaffold building posts 22A, 22B and scaffold building screw104 from backing out of theft respective apertures.

In addition to suture 122, suture anchors (such as anchor portion 142 ofmodified suture 140 discussed above) can be employed for securingcomminuted humeral head portion P relative to scaffold building posts22A, 22B and scaffold building screw 104. For example, various sutureanchors can be used with suture 122, wires, and/or or cables to securecomminuted humeral head portion P. The various suture anchors describedherein can be used as part of fracture fixation systems 10 and 100 andthe other illustrative embodiments described herein.

One or more suture anchors such as an anchor post 130 depicted in FIG. 4can be used to secure comminuted humeral head portion P in positionrelative to scaffold building posts 22A, 22B and scaffold building screw104. Anchor post 130 includes an end portion 132, a threaded shaftportion 134, and an eyelet portion 136. Anchor post 130 can be attachedto scaffold building posts 22A, 22B using bracing apertures 32 and 34,and scaffold building screw 104 using bracing aperture 112. Tofacilitate attachment, threaded shaft portion 134 can engagecomplementary threads provided in bracing apertures 32, 34, and 112.Thereafter, suture 122 can be received through eyelet portion 136 tosecure comminuted humeral head portion P relative to scaffold buildingposts 22A, 22B and scaffold building screw 104.

Furthermore, suture anchors in the form of anchor portion 142 ofmodified suture 140 and a malleable wire 144 are depicted in FIG. 5. Asdepicted in FIG. 5, modified suture 140 includes anchor portion 142 atan end thereof, and malleable wire 144 includes a hook 146 at an endthereof. Like modified suture 140, malleable wire 144 can also be usedto secure comminuted humeral head portion P in position relative toscaffold building posts 22A, 22B and scaffold building screw 104. Ineither instance, modified suture 140 and malleable wire 144 are insertedthrough holes 120 of comminuted humeral head portion P into bracingapertures 32, 34, and 112.

Anchor portion 142 and hook 146 are inserted first through holes 120 andentrances to bracing apertures 32, 34, and 112. When received completelythrough bracing apertures 32, 34, and 112, anchor portion 142 and hook146 prevent withdrawal of modified suture 140 and malleable wire 144,respectively, from holes 120 and bracing apertures 32, 34, and 112. Thatis, when modified suture 140 and malleable wire 144 are under tension,anchor portion 142 and hook 146 catch on the portions of building posts22A, 22B and scaffold building screw 104 adjacent the exits to thecorresponding bracing apertures 32, 34, and 112, and in doing so,prevent withdrawal of modified suture 140 and malleable wire 144 bracingapertures 32, 34, and 112.

Because anchor portion 142 prevents withdrawal, modified suture 140 canbe tied off to secure comminuted humeral head portion P relative toscaffold budding posts 22A, 22B or to scaffold building screw 104; andbecause hook 146 also prevents withdrawal, malleable wire 144 can beused to pin comminuted humeral head portion P relative to scaffoldbuilding posts 22A, 22B or to scaffold building screw 104. Also, becauseanchor portion 142 and hook 146 prevent such withdrawal, scaffoldbuilding posts 22A, 22B and scaffold building screw 104 can be rotatedto wind modified suture 140 (FIGS. 3A and 3B) and malleable wire 146therearound.

A suture anchor for use with suture 122 is generally indicated by thenumeral 160 in FIGS. 6-9. Suture anchor 160 can be used in attachingsuture 122 to scaffold building posts 22A, 22B and scaffold buildingscrew 104. In doing so, suture anchor 160 can be used to securecomminuted humeral head portion Fin position relative to scaffoldbuilding posts 22A, 22B and scaffold building screw 104.

As depicted in FIG. 6, suture anchor 160 is generally harpoon shaped,and includes a first arm portion 162, a second arm portion 164, a bodyportion 166 (including a slot (or cavity) 168 therethrough), and adistal end (or Up) 170. Tip 170 is used to facilitate penetration ofsoft tissues and/or bone. Slot 168 is configured to allow suture 122 tobe received therethrough. For example, as depicted in FIG. 8, suture 122is looped around body portion 166 using slot 168. Furthermore, first andsecond arm portions 162 and 164 can be deformed inwardly toward bodyportion 166 (i.e., compression) and outwardly away from body portion 166(i.e., tension).

First and second arm portions 162 and 164 can be moveable with respectto one another, and can be shaped to facilitate entry into and resistremoval from soft tissues and/or bone. As such, first and second armportions 162 and 164 facilitate attachment of suture 122 (that is alsoattached to suture anchor 160) to the soft tissues and/or bone. Forexample, both first and second arm portions 162 and 164 includegenerally straight sections 172 extending rearwardly from tip 170, andcurved sections 174 extending rearwardly from straight sections 172.Straight sections 172, as depicted in FIG. 6, are acutely angled withrespect to one another. As such, even after compression of first andsecond arm portions 162 and 164 inwardly toward body portion 166,straight sections 172 serve to gradually wedge apertures (not shown)formed through the soft tissues and/or bone open to permit passage ofthe remainder of suture anchor 160. Furthermore, as depicted in FIG. 6,curved sections 174 can he arcuately shaped along the length thereof.After penetration of suture anchor 160 through the soft tissues and/orbone, ends 176 of curved sections 174 can grab the soft tissues and/orbone to prevent removal thereof from the apertures in the soft tissuesand/or bone.

As depicted in FIG. 7, first and second arm portions 162 and 164 canalso be twisted along their lengths. For example, as first and secondarm portions 162 and 164 extend rearwardly from tip 170, first andsecond arm portions 162 and 164 can be twisted in clockwise and/orcounterclockwise directions. In FIG. 7, first and second arm portions162 and 164 are both twisted in clockwise directions.

Suture anchor 160 can be made of a resilient material such as nitinol.As such, suture anchor 160 is biased in the position depicted in FIGS.6-9. Thus, the “memory” afforded by nitinol allows suture anchor 160 toreturn to its original shape after deformation thereof. For example,first and second arm portions 162 and 164 can be contracted andexpanded, and will return to their original positions with respect tobody portion 166 after compression (causing the contraction thereof) ortension (causing the expansion thereof) has been released.

As depicted in FIG. 8, slot 168 of body portion 166 is configured toreceive suture 122 therethrough. Suture 122 can be attached to sutureanchor 160 using slot 168. For example, suture 122 can be looped around(FIG. 8) or tied to suture anchor 160 using slot 168. Thus, as sutureanchor 160 penetrates soft tissues and/or bone, suture 122 is also drawnthrough the apertures in the soft tissues and/or bone.

To aid penetration of suture anchor 160 through soft tissues and/orbone, a hollow needle 180 (FIG. 9) can be provided. As depicted in FIG.9, hollow needle 180 includes a distal end 182, a proximal end 184, anda length extending therebetween. Hollow needle 180 includes a passage186 extending between distal end 182 and proximal end 184, and can beformed from hypodermic tubing. Passage 186 through hollow needle 180 isconfigured to receive suture anchor 160 and suture 122 attached thereto.As depicted in FIG. 9, suture anchor 160 and suture 122 can be insertedthrough hollow needle 180 such that suture anchor 160 is positionedadjacent distal end 182 and suture 122 extends outwardly from proximalend 184. During use, the combined suture anchor 160, suture 122, andhollow needle 180 can penetrate soft tissues and/or bone.

The rigidity afforded by hollow needle 180 allows the combined sutureanchor 160, suture 122, and hollow needle 180 to penetrate relativelyrobust soft tissues and/or bone. Once suture anchor 160 extends into orthrough to the opposite side of the soft tissues and/or bone, hollowneedle 180 can be removed from the soft tissues and/or bone. Thereafter,first and second arm portions 162 and 164 prevent removal from the softtissues and/or bone.

Markings 190 are provided on the exterior of hollow needle 180 to aid inlimiting the depth of penetration of hollow needle 180 through the softtissues and/or bone. Using markings 190, the depth of penetration can begauged. A shoulder 192 is provided to prevent over-penetration of hollowneedle 180. Once in contact with the soft tissues and/or bone, shoulder192 resists further insertion therethrough. Furthermore, threads 194 areprovided on the interior of needle adjacent shoulder 192. Threads 194allow attachment of hollow needle 180 to another tool (not shown) tofacilitate manipulation thereof.

When attached to soft tissues and/or bone, suture anchor 160 (and theportion of suture 122 attached thereto) can be inserted through bracingapertures 32, 34, and 112. Once inserted therein, first and second armportions 162 and 164 resist withdrawal of suture anchor 160 from bracingapertures 32, 34, and 112. That is, once inserted into an entrance ofand completely through the one of bracing apertures 32, 34, and 112,first and second arm portions 162 and 164 serve as catches that interactwith portions of the corresponding scaffold building posts 22A, 22B andscaffold building screw 104 adjacent the one of bracing apertures 32,34, and 112 to prevent withdrawal under tension of suture 122. Thus,suture anchor 160 can serve in attaching suture 122 to scaffold buildingposts 22A, 22B and scaffold building screw 104, and can afford ananchoring point for securing comminuted humeral head portion P toscaffold building posts 22A, 22B and scaffold building screw 104.

FIGS. 10-16 depict other suture anchors for attaching suture 122 toscaffold building posts 22A, 22B and scaffold building screw 104, and,in doing so, securing comminuted humeral head portion P in positionrelative to scaffold building posts 22A, 22B and scaffold building screw104.

FIGS. 10-12 depict a suture anchor 200 having a body portion 202 and aleg portion 204 extending outwardly from body portion 202. Body portion202 is generally cylindrical, and includes an opening 206 therethroughextending between a first end 208 and a second end 210. As depicted inFIGS. 10-12, leg portion 204 extends outwardly from body portion 202 atsecond end 210, and leg portion 204 includes a first surface 212 and asecond surface 214. First and second surfaces 212 and 214 are continuouswith an interior surface 216 and an exterior surface 218, respectively,of body portion 202. Body portion 202 and leg portion 204 can be made ofa resilient material such as nitinol to afford movement of leg portion204 relative to body portion 202.

Suture anchor 200 and suture 122 attached thereto can be receivedthrough bracing apertures 32, 34, and 112, of scaffold building posts22A, 22B and scaffold building screw 104, respectively. For example, asdepicted in FIG. 12, one of scaffold building posts 22A, 22B is depictedwith suture anchor 200 (and suture 122 attached thereto) insertedthrough the corresponding one of bracing apertures 32. As depicted inFIG. 12, leg portion 204 serves as a catch to prevent withdrawal ofsuture anchor 200 through bracing apertures 32, 34, and 112. Thus, whensuture 122 is attached to suture anchor 200, suture anchor 208 can servein attaching suture 122 to scaffold building posts 22A, 22B and scaffoldbuilding screw 104, and can afford an anchoring point for securingcomminuted humeral head portion P to scaffold building posts 22A, 22Band scaffold building screw 104.

Insertion tool 220 can be used to facilitate insertion of suture anchor200 through bracing apertures 32, 34, and 112. Insertion tool 220includes an end portion 222, a first shaft portion 224, a second shaftportion 226, and a shoulder 228 between first and second shaft portions226. End portion 222, as depicted in FIGS. 10-12 can be spherical and issized to afford passage through opening 206 of body portion 202.Shoulder 228 is sized to prevent axial movement of suture anchor 200along insertion tool 220.

To insert suture anchor 200 and suture 122 through bracing apertures 32,34, and 112, suture anchor 200 is slipped over end portion 222 to residebetween end portion 222 and shoulder portion 228 on first shaft portion224. Suture 122 can be attached to suture anchor 200 before or afterreceipt of suture anchor 280 on insertion tool 220. As depicted in FIG.11, shoulder 228 is sized to prevent suture anchor 200 from moving fromfirst shaft portion 224 to second shaft portion 226. Thereafter, sutureanchor 200 is inserted into an entrance of and completely through one ofbracing apertures 32, 34, and 112 using insertion tool 220. Once legportion 204 exits through the one of bracing apertures 32, 34, and 112,insertion tool 220 can be retracted through opening 208 and through theone of bracing apertures 32, 34, and 112. Leg portion 204 serves toprevent withdrawal of suture anchor 200 through the one of bracingapertures 32, 34, and 112. As such, suture 122 is secured to scaffoldbuilding posts 22A, 22B and scaffold building screw 104 corresponding tothe one of bracing apertures 32, 34, and 112 when anchor 200 is insertedcompletely therethrough.

FIGS. 13 and 14 depict suture anchors 230 and 240 used in associationwith an insertion tool 250. Suture anchors 230 and 240 are similar infunction to suture anchor 200, and also can be made of a resilientmaterial such as nitinol. However, rather than using leg portion 204 asa catch for resisting withdrawal from bracing apertures 32, 34, and 112,the bodies of suture anchors 230 and 240 are configured for resistingsuch withdrawal. For example, as depicted in FIG. 13, suture anchor 230includes a body 232 having a first flared portion 234 and a secondflared portion 236 that serve as catches. Furthermore, as depicted inFIG. 14, suture anchor 240 includes a body 242 having a single flaredportion 244 that serves as a catch. When suture 122 is attached tosuture anchors 230 and 240, and suture anchors 230 and 240 are insertedthrough bracing apertures 32, 34, and 112, first and second flaredportions 234 and 236 (of suture anchor 230) and single flared portion244 (of suture anchor 240) prevent withdrawal thereof to secure suture122 to scaffold building posts 22A, 22B and scaffold building screw 104.

As depicted in FIGS. 13, and 14, insertion tool 250 is also similar infunction to insertion tool 220. However, rather than using shoulderportion 228 to prevent movement from first shaft portion 224 to secondshaft portion 226, insertion tool 250 includes an end portion 252, afirst shaft portion 254, and a second shaft portion 256, where secondshaft portion 256 is larger than first shaft portion 254 to prevent suchmovement. Thus, a shoulder 258 is naturally formed at insertion of firstand second shaft portions 264 and 256. Shoulder 258 prevents axialmovement of suture anchors 230 and 240 along insertion tool 250.

FIGS. 15 and 16 depict a suture anchor 260 and an insertion tool 268.Suture anchor 260, in similar fashion to suture anchors 160, 200, 230,and 240, can serve in attaching suture 122 to scaffold building posts22A, 22B and scaffold building screw 104, and can afford an anchoringpoint for securing comminuted humeral head portion P to scaffoldbuilding posts 22A, 22B and scaffold building screw 104.

Suture anchor 260 is generally arrow shaped, and includes a first armportion 262A, a second arm portion 262B, a first body portion 264A, asecond body portion 264B, and a connecting portion 266 between first andsecond body portions 264A and 264B. As discussed below, first and secondarm portions 262A and 262B serve as catches for resisting withdrawalfrom openings such as bracing apertures 32, 34, and 112.

As depicted in FIGS. 15 and 16, first arm portion 262A forms a firstacute angle with respect to first leg portion 264A, and second armportion 262B forms a second acute angle with respect to second legportion 264B. Furthermore, first and second body portions 264A and 264B,and connecting portion 266 together form a generally U-shaped structurethat serves as a cavity for receiving suture 122 therethrough. Insimilar fashion to slot 168 of suture anchor 160, suture 122 can belooped around or tied to suture anchor 260 using the cavity formed byfirst and second body portions 264A and 264B, and connecting portion266.

Suture anchor 260 can be made of a resilient material such as nitinol.Thus, while suture anchor 260 is biased in the position depicted inFIGS. 15 and 16, suture anchor 260 can be contracted and expanded. Thatis, first and second body portions 264A and 264B are moveable toward oneanother under compression (i.e., contraction thereof) and moveable awayfrom one another under tension (i.e., expansion thereof). For example,first and second body portions 264A and 264B at the connections thereofwith first and second arm portions 262A and 262B, respectively. can bemoved toward one another during contraction and can be moved away fromone another during expansion. Furthermore, first and second arm portions262A and 262B can be pivotable relative to first and second bodyportions 264A and 264B, respectively.

Suture anchor 260 can be inserted through bracing apertures 32, 34, and112 using an insertion tool 268. Insertion tool 268 includes a shaftportion 270 (having a distal end 272A and a proximal and 272B) and ahandle portion 274. Shaft portion 270 and handle portion 274 includeopenings 276 and 278, respectively, extending therethrough. Opening 276in shaft portion 270 is sized to receive at least a portion of sutureanchor 260 therein (FIG. 16), and opening 278 in handle portion 274 issized to receive the suture therethrough.

To insert suture anchor 260 and suture 122 through bracing apertures 32,34, and 112, suture 122 is first inserted through opening 276 (in shaftportion 270) and opening 278 (in handle portion 274), and then suture122 is looped around connecting portion 266 of suture anchor 260.Thereafter, at least a portion of suture anchor 260 is received inopening 276 at distal end 272A of shaft portion 270. For example, asdepicted in FIG. 16, connecting portion 266 and portions of first andsecond body portions 264A and 264B are received in opening 276. Toafford receipt of suture anchor 260 therein, opening 276 at distal and272A of shaft portion 270 can be sized larger (FIG. 16) than theremainder thereof, and, if necessary, suture anchor 260 can becontracted in order to facilitate receipt thereof in opening 276.Thereafter, suture anchor 260 can be inserted into an entrance of one ofbracing apertures 32, 34, and 112.

Once first and second arm portions 262A and 262E exit through the one ofbracing apertures 32, 34, and 112, first and second arm portions 262Aand 262B expand to approximate the original shape thereof, and insertiontool 268 can be retracted though the one of bracing apertures 32, 34,and 112. First and second arm portions 262A and 262B then serve inpreventing withdrawal of suture anchor 260 from the one of bracingapertures 32, 34, and 112 through which it has been inserted. That is,if suture 122 attached to suture anchor 260 is tensioned (e.g., in anattempt to withdrawal suture anchor 260 from the one of bracingapertures 32, 34, and 112), contact of first and second arm portions262A and 262B with portions of the corresponding one of scaffoldbuilding posts 22A, 22B and scaffold building screw 104 adjacent theexit of bracing apertures 32, 34, and 122 forces first and second armportions 262A and 262B to pivot away from first and second leg portions264A and 264B, respectively. in doing so, the first acute angle betweenfirst arm portion 262A and first leg portion 264A increases, and thesecond acute angle between second arm portion 262B and second legportion 264B increases. However, while the first and second acute anglesincrease, the first and second angles do not increase enough so that thefirst and second angles are greater than 90-100°. As such, first andsecond arm portions 262A and 262B serve as a catches to preventwithdrawal of suture anchor 200 through bracing apertures 32, 34, and112, thereby attaching suture 122 to the corresponding one of scaffoldbuilding posts 22A, 22B and scaffold building screw 104.

Like suture anchor 160, suture anchor 260 can be used in conjunctionwith hollow needle 180, and can be inserted through soft tissues and/orbone using hollow needle 180. Furthermore, suture anchor 160 can be usedwith insertion tool 268 (in similar fashion to use with suture anchor260) to facilitate insertion of suture anchor 160 through bracingapertures 32, 34, and 112.

While suture anchors 130, 142, 144, 160, 200, 230, 240, and 260 arediscussed in association with bracing apertures 32, 34, and 112, use ofsuture anchors 130, 142, 144, 160, 200, 230, 240, and 260 is not limitedthereto. Suture anchors 130, 142, 144, 160, 200, 230, 240, and 260 canbe used in conjunction with the other illustrative embodiments of thefracture fixation system described herein and other structures providedfor use with the illustrative embodiments. For example, structures (suchas projections, protrusions, protuberances, etc.) can extend outwardlyfrom scaffold building posts 22A, 22B, scaffold building screw 104,plate portions 12 and 102, and/or other components of the illustrativeembodiments of the fracture fixation system described herein.Furthermore, the structures can be indentations and associated latchesor hooks formed in scaffold building posts 22A, 22B, scaffold buildingscrew 104, plate portions 12 and 102, and/or other components of theillustrative embodiments of the fracture fixation system describedherein. Such structures could be configured to capture, hold, orotherwise retain suture anchors 130, 142, 144, 160, 200, 230, 240, and260. Furthermore, such structures could be configured for wrappingsuture 122 therearound, or otherwise securing suture 122 thereto(without use of suture anchors 130, 142, 144, 160, 200, 230, 240, and260). Additionally, suture anchors 142, 144, 160, 200, 230, 240, and 260can also be used in conjunction with anchor post 130. For example,anchor post 130 could be received in the bracing apertures describedherein (e.g., one of bracing apertures 32, 34, and 112), and sutureanchors 142, 144, 160, 200, 230, 240, and 260 could be received througheyelet portion 136 to secure suture 122 thereto.

In addition, another illustrative embodiment of a fracture fixationsystem is generally indicated by the numeral 280 in FIG. 17. Fracturefixation system 280 includes a scaffold building screw 282 for insertionthrough a plate portion (not shown) into a bony structure to interfacewith a cross member 284. Fracture fixation system 280 can be used withfracture fixation systems 10 and 100, and with suture anchors 130, 142,144, 160, 200, 230, 240, and 260. To that end, scaffold building screw282 can be used with external plate portions 12 and 102, and can includeone or more bracing apertures (not shown) for receiving suture anchors130, 142, 144, 160, 200, 230, 240, and 260.

Scaffold building screw 282 includes threads 286 to facilitateattachment to the bony structure. Scaffold building screw 282 includes achannel 288 extending therethrough (between the proximal and distalends) adapted to receive a set screw 290, and includes a head 292, ashaft 294, and a concavity 296 opposite head 292.

Once scaffold building screw 282 is positioned in the bony structure,cross member 284 is also inserted into the bony structure. Cross member284 is inserted transversely relative to scaffold building screw 282 tocontact concavity 296. Cross member 284 can be threaded or non-threaded,and is sized to be received in concavity 296. Cross member 284 includesa threaded aperture 298 that can be aligned with channel 288. Thus, whenchannel 288 and threaded aperture 298 are aligned with one another, setscrew 290 can be inserted through channel 288 into threaded aperture298. Engagement of set screw 290 with threaded aperture 298 securescross member 284 in position relative to scaffold building screw 282. Indoing so, cross member 284 can be rigidly secured to scaffold buildingscrew 282.

A guide member (not shown) can be used to facilitate alignment ofscaffold building screw 282 and cross member 284. For example, the guidemember can be positioned relative to scaffold building screw 282 and/orthe plate portion (e.g., the external plate portions 12 and 102)receiving scaffold building screw 282 to insure proper positioning ofcross member 284. Furthermore, a portion (e.g., head 292) of scaffoldbuilding screw 282 and/or a portion of cross member 284 can include anindicia to afford the proper orientation thereof to facilitate receiptof cross member 284 in concavity 296 and alignment of channel 288 andthreaded aperture 298.

FIGS. 18-26 depict further illustrative embodiments of fracture fixationsystems generally indicated by the numerals 300, 400, 420, 440, 460,480, 500, and 540. Fracture fixation systems depicted in FIGS. 18-26 canbe used with fracture fixation systems 10, 100, and 280, and with sutureanchors 130, 142, 144, 160, 200, 230, 240, and 260. As such, bracingapertures associated with fixation systems 300, 400, 420, 440, 460, 480,500, and 540 can be configured for receipt of suture anchors 130, 142,144, 160, 200, 230, 240, and 260.

FIGS. 18 and 19 depict an illustrative embodiment of fracture fixationsystem generally indicated by the numeral 300. Fracture fixation system300 includes an external plate portion 312 similar to external plateportions 12 and 102 of fracture fixation systems 10 and 100,respectively. External plate portion 312 can be elongated to affordattachment to humeral shaft portion 16 of humeral bone H (depicted inFIGS. 1 and 2) in similar fashion to external plate portions 12 and 102.

External plate portion 312 includes an upper surface 318 and a lowersurface 320, and, as depicted in FIGS. 18 and 19, lower surface 320 canbe contoured to the shape of portions of humeral bone H. For example,portions of lower surface 320 can be contoured to the shape of portionsof comminuted humeral head, and other portions of lower surface 320 canbe contoured to the shape of humeral shaft portion 16.

External plate portion 312 can include screw apertures (not shown) forattaching external plate portion 312 to humeral bone H using platescrews not shown) in similar fashion to fracture fixation systems 10 and100. The screw apertures for receiving the plate screws extend betweenupper surface 318 and lower surface 320, and can be provided along thelength of external plate portion 312. As such, the screw apertures andthe plate screws received therein can be used to attach external plateportion 312 to the external surfaces of humeral shaft portion 16.Furthermore, depending on whether additional portions of the comminutedhumeral head remain attached to humeral shaft portion 16, external plateportion 12 can also be attached to the exterior surfaces thereof usingthe plate screws.

Like fracture fixation systems 10 and 100, fracture fixation system 300also can include attachment structures in the form of one or morescaffold building posts and/or screws for facilitating attachment ofcomminuted humeral head portion P. As depicted in FIGS. 18 and 19,fracture fixation system 300 includes two scaffold budding posts 322Aand 322B received in scaffold building post apertures 324A and 324B. Asdepicted in FIGS. 18 and 19, scaffold building posts 322A and 322B canbe secured relative to external plate portion 312.

Scaffold building posts 322A and 322B each include a shaft 328 and ahead 330. Shaft 328 can be provided with threads (not shown) tofacilitate attachment thereof to larger portions of the comminutedhumeral head. If necessary, scaffold building posts 322A and 322B can belocked to scaffold budding post apertures 324A and 324B, respectively,using cooperating threads (not shown) on exterior of heads 330 and onthe interior of scaffold building post apertures 324A and 324B.

Scaffold building posts 322A and 322B can be provided with or withoutfenestrations. If no fenestrations are provided, sutures, wires, and/orcables can be wrapped around scaffold building posts 322A and 322B tofacilitate attachment of comminuted humeral head portion P thereto.Furthermore, if fenestrations are provided, shafts 328 of scaffoldbuilding posts 322A and 322B can include one or more bracing apertures332 formed therethrough. As depicted in FIG. 18, scaffold building posts322A and 322B each include one of bracing apertures 332. As discussedbelow, bracing apertures 332 can receive a cross member 340 or canreceive sutures, wires, cables, and/or suture anchors. Moreover,fenestrations (not shown) can also be provided in cross member 340, andthe fenestrations in cross member 340 can also receive sutures, wires,cables, and/or suture anchors.

Bracing apertures 332 can extend transversely through shafts 328 of eachof scaffold building posts 322A and 322B. Bracing apertures 332 may bedisposed in a generally perpendicular relationship or at any desiredangle with respect to the longitudinal axes of shafts 328. Moreover, ifmultiple bracing apertures 332 are provided in one of shafts 328, themultiple bracing apertures 332 may be disposed in generallyperpendicular or transverse relationships with respect to each other.

In addition to the attachment structures in the form of scaffoldbuilding posts 322A and 322B, as depicted in FIGS. 18 and 19, fracturefixation system 300 includes a fin 350 extending outwardly from lowersurface 320. Fin 350 and fins of other illustrative embodiments of thefracture fixation system disclosed herein can be plate-like projectionshaving various shapes and dimensions, and apertures can be provided infin 350 and the other fins for receiving cross members, sutures (such assuture 122), wires, cables, and/or suture anchors (such as sutureanchors 130, 142, 144, 160, 200, 230, 240, and 260).

As depicted in FIGS. 18 and 19, fin 350 includes a first side 352, asecond side 354, a length measured outwardly from lower surface 320, anda thickness perpendicular to the length. The width of fin 350 isperpendicular to the length and the thickness thereof, and, because thewidth of fin 350 is aligned with the length of external plate portion312, is not shown in FIGS. 18 and 19. As discussed below, the position,number, angles, and curvature of the fin or fins can be varied inassociation with fracture fixation systems 300, 400, 420, 440, 460, and480. Regarding position, fin 350 and fins of other illustrativeembodiments of the fracture fixation system disclosed herein, forexample, can be positioned proximate the center of exterior plateportion 312, proximate one or more edges of exterior plate portion 312,or anywhere therebetween.

Fin 350 can include one or more bracing apertures 360 formedtherethrough extending between first and second sides 352 and 354. Asdepicted in FIGS. 18 and 19, fin 350 includes one of bracing apertures360. Furthermore, like bracing apertures 332 formed in scaffold buildingposts 322A and 322B, bracing aperture 360 can receive cross member 340therethrough or can receive sutures, wires, cables, and/or sutureanchors.

As depicted in FIG. 18, when using cross member 340, bracing apertures332 and bracing apertures 360 can be aligned with one another to affordpassage of cross member 340 through scaffold building posts 322A and322B, and fin 350. Cross member 340 can be connected to scaffoldbuilding posts 322A and 322B, and fin 350, and can be used to attachcomminuted humeral head portion P to fin 350, and hence, to otherportions of humeral bone H. Furthermore, bracing apertures 332 (ofscaffold building posts 322A and 322B) and bracing apertures 360 (of fin350) can be threaded to engage complementary threads provided on thecross member 340 to strengthen the connection therebetween.

When using sutures, wires, cables, and/or suture anchors, suture anchor260 (and an attached suture, wire, or cable) can be received throughbracing aperture 360 to facilitate attachment of comminuted humeral headportion P to fin 350, and hence, to other portions of humeral bone H.For example, as depicted in FIG. 19, suture anchor 260 is attached tosuture 122, and comminuted humeral head portion P is being attached tofin 350 using suture 122 and suture anchor 260. Furthermore, thesutures, wires, cables, and/or suture anchors can be used to secureassociated tissue T to comminuted humeral head portion P and otherportions of humeral bone H.

While not depicted in FIG. 19, scaffold building posts 322A and 322B caninclude bracing apertures 332 aligned with bracing aperture 360. Assuch, in addition to bracing aperture 360, suture 122 and suture anchor260 attached thereto could be received through bracing apertures 332(not shown in FIG. 18) formed in scaffold building posts 322A and 322B.Furthermore, in similar fashion to fixation systems 10 and 100, one ofscaffold building posts 322A and 322B could be rotated to repositionbracing apertures 332 formed therein rotationally and wind suture 122around shaft 328. That is, one of scaffold building posts 322A and 322Bcould be rotated so long as attachment of suture 122 and suture anchor260 to fin 350 and/or the other of scaffold building posts 322A and 322Bdoes interfere with such rotation. Such rotation would draw comminutedhumeral head portion P toward fin 350 and scaffold building posts 322A,322B.

Illustrative embodiments 400, 420, and 440 of the fracture fixationsystem disclosed herein are depicted in FIGS. 20-22, respectively.Fracture fixation system 400 depicted in FIG. 20 includes an exteriorplate portion 402 having a lower surface 404 and a single fin 406extending outwardly from lower surface 404—the width of fin 406 isaligned with the longitudinal axis (or along the length) of exteriorplate portion 402, Fracture fixation system 420 depicted in FIG. 21includes an exterior plate portion 422 having a lower surface 424 andtwo fins 426 and 428 extending outwardly from lower surface 424—fins 426and 428 are spaced apart from one another and the widths of fins 426 and428 are aligned with the longitudinal axis (or along the length) ofexterior plate portion 422. Fracture fixation system 440 depicted inFIG. 22 includes an exterior plate portion 442 having a lower surface444 and a single fin 446—the width of fin 446 is oriented transverselyto the longitudinal axis (or across the longitudinal axis) of exteriorplate portion 442.

As depicted in FIGS. 20-22, exterior plate portions 402, 422, and 442can include screw apertures 410, 430, and 460, respectively, spacedtherealong for receiving plate screws (not shown) therethrough. Theplate screws can be used to attach exterior plate portions 402, 422, and442 to the external surface of humeral shaft portion 16. Furthermore,depending on whether additional portions of the comminuted humeral headremain attached to humeral shaft portion 16, external plate portions402, 422, and 442 can also be attached to the exterior surfaces thereofusing the plate screws. Like lower surface 320 of exterior plate portion312 of fracture fixation system 300, portions of lower surfaces 404,424, and 444 of exterior plate portions 402, 422, and 442, respectively,can be contoured to portions of the comminuted humeral head, and otherportions of lower surfaces 404, 424, and 444 can be contoured to theshape of humeral shaft portion 16.

Like fin 350 of fracture fixation 300, fin 406, fins 426 and 428, andfin 446 can include bracing apertures 412, 432, and 452, respectively,for receiving cross members, sutures, wires, cables, and/or sutureanchors. Furthermore, exterior plate portions 402, 422, and 442 caninclude apertures 414, 434, and 454 for receiving scaffold buildingposts (not shown) and/or scaffold building screws (not shown). Thescaffold building posts and/or scaffold building screws of the fracturefixation systems 400, 420, and 440 can also include apertures (notshown) for receiving cross members, sutures, wires, cables, and/orsuture anchors. As such, the cross members, sutures, wires, cables,and/or suture anchors can be received through bracing apertures 412,432, and 452 and corresponding apertures formed in the scaffold buildingposts and/or scaffold building screws of fracture fixation systems 400,420, and 440.

Illustrative embodiments 460 and 480 of the fracture fixation systemdisclosed herein are depicted in FIGS. 23 and 24, respectively. Fracturefixation systems 460 and 480 can incorporate the features of fracturefixation systems 300, 400, 420, and 440, and, as depicted in FIGS. 23and 24 include exterior plate portions 462 and 482, respectively.Fracture fixation system 460 includes a fin 464, a first end 466, and asecond end 468, and fin 464 is both oriented transversely to thelongitudinal axis (or across the longitudinal axis) of exterior plateportion 462, and curved toward first end 466; and fracture fixationsystem 480 includes a fin 484, a first end 486, and a second end 488,and fin 484 is both oriented transversely to the longitudinal axis (oracross the longitudinal axis) of exterior plate portion 482, and angledtoward first end 486.

While fins 464 and 484 are depicted as being curved and angled,respectively, toward first ends 466 and 486 in FIGS. 23 and 24, fins 464and 484 can also be curved and angled toward second ends 468 and 488.Moreover, the curvature and angles of fins 464 and 484, respectively,can be varied, and the transverse orientation of fins 464 and 484relative to the longitudinal axes of exterior plate portions 462 and482, respectively, can also be varied. Furthermore, multiple fins 464and 484 can be provided in association with fracture fixation systems460 and 480. Fins 464 and 484 can include apertures 470 and 490,respectively, for receiving cross members, sutures, wires, cables,and/or suture anchors. For example, as depicted in FIGS. 23 and 24,comminuted humeral head portion P is being secured to fins 464 and 484,respectively, using suture 122 and suture anchors 260 received throughapertures 470 and 490.

Illustrative embodiment 500 of the fracture fixation system disclosedherein is depicted in FIGS. 25 and 26, and illustrative embodiment 540of the fracture fixation system disclosed herein is depicted in FIGS. 27and 28, Fracture fixation systems 500 and 540 can incorporate thefeatures of fracture fixation systems 300, 400, 420, 440, 460, and 480.

Fracture fixation system 500 depicted in FIG. 26 includes an exteriorplate portion 502 and a fin element 504 (FIGS. 25 and 26) shaped as a“T” attached to exterior plate portion 502. Fin element 504 includes abase portion 506 and an extension portion 508 extending outwardly frombase portion 506. In addition to apertures (not shown) for receivingplate screws and/or scaffold building screws (not shown), exterior plateportion 502 includes a slot 510 and a groove (or retaining recess 512formed therein. Slot 510 is sized to receive extension portion 508therethrough, and groove 512 is sized to receive base portion 506therein. When assembled, extension portion 508 extends outwardly fromexterior plate portion 502, and base portion 506 is nested in groove512. To attach fin element 504 to exterior plate portion 502, screws(not shown) can be inserted through apertures 516 formed through baseportion 506 and received in corresponding apertures (not shown) formedin exterior plate portion 502. Like the fins 350, 406, 426, 428, 446,464, and 484, extension portion 508 can include bracing apertures 518formed therethrough for receiving cross members, sutures, wires, cables,and suture anchors.

Fracture fixation system 540 depicted in FIG. 28 includes an exteriorplate portion 542 and a fin element 544 (FIGS. 27 and 28) shaped as an“L” attached to exterior plate portion 542. Fin element 544 includes abase portion 546 and an extension portion 548 extending outwardly frombase portion 546. In addition to apertures (not shown) for receivingplate screws and/or scaffold building posts (not shown), exterior plateportion 542 includes a slot 550 and a groove (or retaining recess) 552formed therein. Slot 550 is sized to receive extension portion 548therein. When assembled, extension portion 548 extends outwardly fromexterior plate portion 542, and base portion 546 is nested in groove562. To attach fin element 544 to exterior plate portion 542, screws(not shown) can be inserted through apertures 556 formed through baseportion 546 and received in corresponding apertures (not shown) inexterior plate portion 542. Like fins 350, 406, 426, 428, 446, 464, and484, extension portion 548 can include bracing apertures 558 formedtherethrough for receiving cross members, sutures, wires, cables, andsuture anchors.

Furthermore, while fin elements 504 and 544 have “T” and “L” shapes,respectively, extension portions 508 and 548 can also be curved, angled,and oriented in similar fashion to fins 350, 406, 426, 428, 446, 464,and 484. Furthermore, multiple fin elements 504 and 544 can be providedin association with fracture fixation systems 500 and 540.

In summary, fracture fixation systems 10, 100, 280, 300, 400, 420, 440,460, 480, 500, and 540 facilitate repair and reattachment of thecomminuted humeral head and tissue associated therewith to the remainderof humeral bone H. Furthermore, suture anchors 130, 142, 144, 160, 200,230, 240, and 260 aid in anchoring comminuted humeral head portion P andassociated tissue T to components of fracture fixation systems 10, 100,280, 300, 400, 420, 440, 460, 480, 500, and 540, and hence, relative toone another and humeral bone H to facilitate healing. Although fracturefixation systems 10, 100, 280, 300, 400, 420, 440, 460, 480, 500, and540 are described in association with the comminuted humeral head andthe tissue associated therewith, fracture fixation systems 10, 100, 280,280, 300, 400, 420, 440, 460, 480, 500, and 540 are not so limited.Fracture fixation systems 10, 100, and 280 can be used elsewhere in thebody to repair and reattach comminuted bone portions and tissueassociated therewith. Other embodiments of the invention will beapparent to those skilled in the art from consideration of thespecification and practice of the invention disclosed herein.Accordingly, it is intended that the specification and examples beconsidered as exemplary only.

1. A method for repairing a comminuted humeral head of a humeral bone,the method comprising the acts of: providing a plate having an uppersurface, a lower surface opposite the upper surface, and at least oneaperture for receiving one of a screw and a post therethrough; securingthe plate to a portion of a humeral shaft of the humeral bone; insertingthe one of the screw and the post through the at least one aperturethrough the plate; attaching a portion of the comminuted humeral head tothe one of the screw and the post using at least one suture; androtating the one of the screw and the post to wind the at least onesuture around the one of the screw and the post, wherein the winding ofthe at least one suture draws the portion of the comminuted humeral headcloser to the one of the screw and the post to position the portion ofthe comminuted humeral head relative to the portion of the humeralshaft.
 2. The method of claim 1, wherein the at least one suture isattached to the one of the screw and the post using a hole formed in theone of the screw and the post.
 3. The method of claim 2, wherein, duringrotation of the one of the screw and the post, the hole is rotated froma first position to a second position.
 4. The method of claim 3, whereinthe one of the screw and the post includes a mid-longitudinal axis, andthe hole includes a central longitudinal axis perpendicularly aligned tothe mid-longitudinal axis of the post.
 5. The method of claim 1, whereinthe plate is attached to the portion of the humeral shaft using at leastone plate screw inserted through the plate and into the humeral shaft.6. The method of claim 1, further comprising the act of providing asuture anchor for inhibiting withdrawal thereof from a hole formed inthe one of the screw and the post, and wherein, to attach the portion ofthe comminuted humeral head to the one of the screw and the post, the atleast one suture is attached to both the suture anchor and thecomminuted humeral head portion, and the suture anchor is insertedthrough the hole formed in the one of the screw and the post.
 7. Themethod of claim 1, further comprising the act of providing a sutureanchor, and wherein the act of attaching comprises the sub-acts ofattaching a first portion of the at least one suture to the sutureanchor, attaching a second portion of the at least one suture to theportion of the comminuted humeral head, and inserting the suture anchorand the first portion of the at least one suture at least partiallythrough a hole formed in the one of the screw and the post, the sutureanchor being configured to resist withdrawal thereof from the hole. 8.The method of claim 7, wherein the suture anchor includes a cavity forattaching the first portion of the at least one suture thereto, and atleast one catch for resisting withdrawal of the suture anchor throughthe hole.
 9. The method of claim 8, wherein the act of attaching furthercomprises the sub-act of contacting the at least one catch to a portionof the one of the screw and the post adjacent an exit of the hole. 10.The method of claim 7, further comprising the act of providing aninsertion tool adapted to receive the suture anchor and the firstportion of the at least one suture in an end portion thereof, andwherein the sub-act of inserting the suture anchor and the first portionof the at one suture comprises receiving the suture anchor and the firstportion of the at least one suture in the end portion of the insertiontool, inserting the end portion of the insertion tool into an entranceof and through the hole formed in the one of the screw and the post sothat the at least one catch protrudes from an exit of the hole,disengaging the suture anchor and the first portion of the at least onesuture from the insertion tool, and removing the insertion tool from thehole.
 11. The method of claim 10, wherein the sub-act act of insertingfurther comprises contacting the at least one catch to a portion of theone of the screw and the post adjacent the exit of the hole to resistwithdrawal through the hole.
 12. The method of claim 7, furthercomprising the act of providing at least one fin extending outwardlyfrom the lower surface of the plate, a first fin of the at least one finincluding an aperture therethrough, and wherein the act of inserting oneof the screw and the post further comprises the sub-act of aligning thehole of the one of the screw and the post with the aperture of the firstfin, and the act of attaching further comprises the sub-act of insertingthe suture anchor through the hole and the aperture.
 13. The method ofclaim 12, wherein the plate has a longitudinal axis along the greatestdimension thereof, and the first fin has a length and a widthperpendicular to the length, the length of the fin extending outwardlyfrom the lower surface of the plate, and the width being in a planealigned with the longitudinal axis of the plate.
 14. The method of claim12, wherein the first fin is detachable from the plate.
 15. The methodof claim 13, further comprising the act providing a second fin having awidth aligned with the width of the first fin.
 16. The method of claim7, wherein the one of the screw and the post includes a head forcontacting the interior of the at least one aperture, the head and theinterior each including complementary threads to prevent unwanted axialmovement of the one of the screw and the post relative to the plate, andeach including complementary ratchetings to prevent unwanted rotationalmovement of the one of the screw and the post relative to the plate. 17.A method for repairing a comminuted humeral head of a humeral bone, themethod comprising the acts of: providing a plate having an uppersurface, a lower surface opposite the upper surface, at least one finextending outwardly from the lower surface of the plate, and at leastone aperture for receiving one of a screw and a post therethrough;securing the plate to a portion of a humeral shaft of the humeral bone;inserting the one of the screw and the post through the at least oneaperture through the plate; attaching a portion of the comminutedhumeral head to the one of the screw and the post using at least onesuture, the at least one suture being received through an apertureformed in the at least one fin and through a hole formed in the one ofthe screw and the post; and rotating the one of the screw and the postto wind the at least one suture around the one of the screw and thepost, wherein the winding of the at least one suture draws the portionof the comminuted humeral head closer to the at least one fin and to theone of the screw and the post, wherein the at least one fin ispositioned between the portion of the comminuted humeral head and theone of the screw and the post.
 18. The method of claim 17, wherein theat least one suture is attached to the one of the screw and the postusing the hole formed in the one of the screw and the post, and wherein,during rotation of the one of the screw and the post, the hole isrotated from a first position to a second position.
 19. The method ofclaim 17, further comprising the act of providing a suture anchor, andwherein the act of attaching comprises the sub-acts of attaching a firstportion of the at least one suture to the suture anchor, attaching asecond portion of the at least one suture to the portion of thecomminuted humeral head, and inserting the suture anchor and the firstportion of the at least one suture through the aperture formed in the atleast one fin and at least partially through the hole formed in the oneof the screw and the post, the suture anchor being configured to resistwithdrawal thereof from the hole.
 20. The method of claim 19, furthercomprising the act of providing an insertion tool adapted to receive thesuture anchor and the first portion of the at least one suture in an endportion thereof, and wherein the sub-act of inserting the suture anchorand the first portion of the at one suture comprises receiving thesuture anchor and the first portion of the at least one suture in theend portion of the insertion tool, inserting the end portion completelythrough the aperture formed in the at least one fin, inserting the endportion of the insertion tool into an entrance of and through the holeformed in the one of the screw and the post so that at least one catchformed on the suture anchor protrudes from an exit of the hole,disengaging the suture anchor and the first portion of the at least onesuture from the insertion tool, and removing the insertion tool from thehole.